* 1. Please select the site at which your doctor or nurse practitioner is located:

* 2. The last time you were sick or were concerned you had a health problem, did you get an appointment on the date you wanted?

* 3. The last time you were sick, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office?

* 4. The last time you were sick and you tried to see your doctor or nurse practitioner were you offered a same or next day appointment to see him/her or someone else in their office within this time frame, even if you were unable to accept the appointment?

* 5. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the length of time it took between making your appointment and the visit you just had?

* 6. When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?

* 7. When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?

* 8. When you see your doctor or nurse practitioner, how often do they or someone else in the office spend enough time with you?

* 9. Thinking about your most recent visit, on a scale of poor to excellent, how comfortable do you feel talking with your doctor or nurse practitioner about personal problems related to your health condition?

* 10. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your doctor or nurse practitioner on listening to your concerns?

* 11. Thinking about your most recent visit, on a scale of poor to excellent, did your doctor or nurse practitioner) let you say what was important?

* 12. Thinking about your most recent visit, on a scale of poor to excellent, did your doctor or nurse practitioner take your health concerns seriously?

* 13. Thinking about your most recent visit, on a scale of poor to excellent, was your doctor or nurse practitioner concerned about your feelings?

* 14. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your overall experience with our office staff?

* 15. Any additional comments regarding the Family Health Team in general, appointment bookings, staff, primary care providers, or programming.

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